Standards of care for medical management of acromegaly in pituitary tumor centers of excellence (PTCOE).

Acromegaly Cabergoline Lanreotide Octreotide Pasireotide Pegvisomant

Journal

Pituitary
ISSN: 1573-7403
Titre abrégé: Pituitary
Pays: United States
ID NLM: 9814578

Informations de publication

Date de publication:
04 Jun 2024
Historique:
accepted: 26 04 2024
medline: 4 6 2024
pubmed: 4 6 2024
entrez: 4 6 2024
Statut: aheadofprint

Résumé

A series of consensus guidelines on medical treatment of acromegaly have been produced in the last two decades. However, little information is available on their application in clinical practice. Furthermore, international standards of acromegaly care have not been published. The aim of our study was to report current standards of care for medical therapy of acromegaly, using results collected through an audit performed to validate criteria for definition of Pituitary Tumor Centers of Excellence (PTCOE). Details of medical treatment approaches to acromegaly were voluntarily provided by nine renowned international centers that participated in this audit. For the period 2018-2020, we assessed overall number of acromegaly patients under medical treatment, distribution of patients on different treatment modalities, overall biochemical control rate with medical therapy, and specific control rates for different medical treatment options. Median number of total patients and median number of new patients with acromegaly managed annually in the endocrinology units of the centers were 206 and 16.3, respectively. Median percentage of acromegaly patients on medical treatment was 48.9%. Among the patients on medical treatment, first-generation somatostatin receptor ligand (SRL) monotherapy was used with a median rate of 48.7%, followed by combination therapies with a median rate of 29.3%. Cabergoline monotherapy was used in 6.9% of patients. Pegvisomant monotherapy was used in 7 centers and pasireotide monotherapy in 5 centers, with median rates of 7.9% and 6.3%, respectively. Current standards of care in PTCOEs include use of first-generation SRLs as the first medical option in about 50% of patients, as recommended by consensus guidelines. However, some patients are kept on this treatment despite inadequate control suggesting that cost-effectiveness, availability, patient preference, side effects, and therapeutic inertia may play a possible role also in PTCOE. Moreover, at odds with consensus guidelines, other monotherapies for acromegaly appear to have a marginal role as compared to combination therapies as extrapolated from PTCOE practice data. Presence of uncontrolled patients in each treatment category suggest that further optimization of medical therapy, as well as use of other therapeutic tools such as radiosurgery may be needed.

Identifiants

DOI: 10.1007/s11102-024-01397-w PMID: 38833044
pubmed: 38833044
doi: 10.1007/s11102-024-01397-w
pii: 10.1007/s11102-024-01397-w
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

© 2024. The Author(s).

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Auteurs

Andrea Giustina (A)

Institute of Endocrine and Metabolic Sciences, San Raffaele Vita-Salute University and San Raffaele IRCCS Hospital, Via Olgettina 60, Milan, 20132, Italy. giustina.andrea@hsr.it.

M M Uygur (MM)

Institute of Endocrine and Metabolic Sciences, San Raffaele Vita-Salute University and San Raffaele IRCCS Hospital, Via Olgettina 60, Milan, 20132, Italy.
Department of Endocrinology and Metabolism Disease, School of Medicine, Recep Tayyip Erdoğan University, Rize, Turkey.

S Frara (S)

Institute of Endocrine and Metabolic Sciences, San Raffaele Vita-Salute University and San Raffaele IRCCS Hospital, Via Olgettina 60, Milan, 20132, Italy.

A Barkan (A)

Division of Endocrinology, University of Michigan Health System, Ann Arbor, MI, USA.

N R Biermasz (NR)

Center for Endocrine Tumors Leiden, Leiden University Medical Center, Leiden, The Netherlands.

P Chanson (P)

Physiologie et Physiopathologie Endocriniennes, Service d'Endocrinologie et des Maladies de la Reproduction et Centre de Référence des Maladies Rares de l'Hypophyse HYPO, Université Paris-Saclay, APHP, Hôpital Bicêtre, Le Kremlin-Bicêtre, Inserm, Paris, France.

P Freda (P)

Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA.

M Gadelha (M)

Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria Estadual de Saúde do Rio de Janeiro, Rio de Janeiro, Brazil.

L Haberbosch (L)

Department of Medicine for Endocrinology, Diabetes and Nutritional Medicine, Charité Universitätsmedizin, Berlin, Germany.

U B Kaiser (UB)

Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA.

S Lamberts (S)

Erasmus Medical Center, Rotterdam, The Netherlands.

E Laws (E)

Pituitary/Neuroendocrine Center, Brigham & Women's Hospital, Boston, MA, USA.

L B Nachtigall (LB)

Neuroendocrine Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.

V Popovic (V)

Medical Faculty, University of Belgrade, Belgrade, Serbia.

M Reincke (M)

Department of Medicine IV, LMU University Hospital, LMU Munich, Munich, Germany.

A J van der Lely (AJ)

Pituitary Center Rotterdam and Endocrinology Section, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands.

J A H Wass (JAH)

Department of Endocrinology, Churchill Hospital, University of Oxford, Oxford, United Kingdom.

S Melmed (S)

Pituitary Center, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA.

F F Casanueva (FF)

Division of Endocrinology, Santiago de Compostela University and Ciber OBN, Santiago, Spain.

Classifications MeSH